title: Early and late outcomes in patients excluded from same-day home discharge after transradial stenting and maximal antiplatelet therapy.
abstract: BACKGROUND
  To develop a safe practice of same-day discharge after percutaneous coronary intervention (PCI), it is important to identify early the patients who need to remain hospitalized and potentially require more careful follow-up. In the EASY trial, a large number of patients with acute coronary syndromes were enrolled prior to PCI to be randomized between same-day discharge or overnight hospitalization. Based on a few angiographic criteria, suboptimal results, or clinical complications, some patients were excluded from randomization after PCI.
  
  
  OBJECTIVE
  We report the early and late outcomes of those patients, and evaluate the use of simple criteria precluding same-day discharge.
  
  
  RESULTS
  The rate of major adverse cardiac events including death, myocardial infarction, and target vessel revascularization in patients excluded from randomization (n = 343) was significantly higher at 30 days (10.2% vs. 1.6%), 6 months (17.5% vs. 5.6%), and 12 months (24.5% vs. 9%) compared with randomized patients (n = 1,005; P < 0.0001). At 12 months, only transient vessel closure (HR 1.78, 95% CI 1.10-2.65, P = 0.023) and a residual dissection >or= grade B post-PCI (HR 1.53, 95% CI 1.11-2.05, P = 0.011) were independent predictive factors of adverse outcomes.
  
  
  CONCLUSIONS
  Criteria associated with angiographic suboptimal results or clinical complications are useful to identify patients ineligible for same-day discharge after PCI, regardless of the clinical presentation. Patients excluded from same-day discharge after PCI for safety concerns have worse early and late outcomes. Transient vessel closure and persisting moderate dissection after PCI remain independent predictors of late adverse outcomes after PCI with maximal antiplatelet therapy.
authors.affiliation: Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie, Quebec, Canada. olivier.bertrand@crhl.ulaval.ca
authors.forename: Olivier F
authors.initials: OF
authors.lastname: Bertrand
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
authors.forename: Eric
authors.initials: E
authors.lastname: Larose
authors.forename: Guy
authors.initials: G
authors.lastname: Proulx
authors.forename: Onil
authors.initials: O
authors.lastname: Gleeton
authors.forename: Can Manh
authors.initials: CM
authors.lastname: Nguyen
authors.forename: Isabelle
authors.initials: I
authors.lastname: Nault
authors.forename: Louis
authors.initials: L
authors.lastname: Roy
authors.forename: Paul
authors.initials: P
authors.lastname: Poirier
authors.forename: Olivier
authors.initials: O
authors.lastname: Costerousse
authors.forename: Robert
authors.initials: R
authors.lastname: De Larochellière
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009551:Night Care; D010351:Patient Discharge; D018579:Patient Selection; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017534:Radial Artery; D018570:Risk Assessment; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors